Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1990 Jul;212(1):14–22. doi: 10.1097/00000658-199007000-00003

Transplantation of two patients with one liver. Analysis of a preliminary experience with 'split-liver' grafting.

J C Emond 1, P F Whitington 1, J R Thistlethwaite 1, D Cherqui 1, E A Alonso 1, I S Woodle 1, P Vogelbach 1, S M Busse-Henry 1, A R Zucker 1, C E Broelsch 1
PMCID: PMC1358069  PMID: 2363599

Abstract

Surgical reduction of donor livers to treat small children has been performed successfully in several centers. While this procedure improves the allocation of livers, it does not increase the organ supply. We have extended reduced-size orthotopic liver transplantation (OLT) to treat 18 patients with 9 livers, accounting for 26% of our transplants during a 10-month period and have evaluated the results. In 18 split liver OLTs, patient survival was 67% and graft survival was 50%. In comparison, for 34 patients treated with full-size OLT during the same period, patient survival was 84% (p = 0.298) and graft survival was 76% (p = 0.126). Biliary complications were significantly more frequent in split grafts, occurring in 27%, as compared to 4% in full-sized grafts (p = 0.017). Primary nonfunction (4% versus 5.5%) and arterial thrombosis (6% versus 9%) occurred with similar frequency in split and full-size OLT (p = not significant). These results demonstrated that split-liver OLT is feasible and could have a substantial impact in transplant practice. We believe that biliary complications can be prevented by technical improvements and that split-liver OLT will improve transplant therapy by making more livers available.

Full text

PDF

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bismuth H., Houssin D. Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery. 1984 Mar;95(3):367–370. [PubMed] [Google Scholar]
  2. Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg. 1982 Jan;6(1):3–9. doi: 10.1007/BF01656368. [DOI] [PubMed] [Google Scholar]
  3. Broelsch C. E., Emond J. C., Thistlethwaite J. R., Rouch D. A., Whitington P. F., Lichtor J. L. Liver transplantation with reduced-size donor organs. Transplantation. 1988 Mar;45(3):519–524. doi: 10.1097/00007890-198803000-00003. [DOI] [PubMed] [Google Scholar]
  4. Broelsch C. E., Emond J. C., Thistlethwaite J. R., Whitington P. F., Zucker A. R., Baker A. L., Aran P. F., Rouch D. A., Lichtor J. L. Liver transplantation, including the concept of reduced-size liver transplants in children. Ann Surg. 1988 Oct;208(4):410–420. doi: 10.1097/00000658-198810000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Emond J. C., Whitington P. F., Thistlethwaite J. R., Alonso E. M., Broelsch C. E. Reduced-size orthotopic liver transplantation: use in the management of children with chronic liver disease. Hepatology. 1989 Nov;10(5):867–872. doi: 10.1002/hep.1840100520. [DOI] [PubMed] [Google Scholar]
  6. Esquivel C. O., Koneru B., Karrer F., Todo S., Iwatsuki S., Gordon R. D., Makowka L., Marsh W. J., Jr, Starzl T. E. Liver transplantation before 1 year of age. J Pediatr. 1987 Apr;110(4):545–548. doi: 10.1016/s0022-3476(87)80545-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kalayoglu M., Sollinger H. W., Stratta R. J., D'Alessandro A. M., Hoffmann R. M., Pirsch J. D., Belzer F. O. Extended preservation of the liver for clinical transplantation. Lancet. 1988 Mar 19;1(8586):617–619. doi: 10.1016/s0140-6736(88)91416-x. [DOI] [PubMed] [Google Scholar]
  8. Malatack J. J., Schaid D. J., Urbach A. H., Gartner J. C., Jr, Zitelli B. J., Rockette H., Fischer J., Starzl T. E., Iwatsuki S., Shaw B. W. Choosing a pediatric recipient for orthotopic liver transplantation. J Pediatr. 1987 Oct;111(4):479–489. doi: 10.1016/s0022-3476(87)80105-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Mazzaferro V., Esquivel C. O., Makowka L., Belle S., Kahn D., Koneru B., Scantlebury V. P., Stieber A. C., Todo S., Tzakis A. G. Hepatic artery thrombosis after pediatric liver transplantation--a medical or surgical event? Transplantation. 1989 Jun;47(6):971–977. doi: 10.1097/00007890-198906000-00011. [DOI] [PubMed] [Google Scholar]
  10. Otte J. B., Yandza T., de Ville de Goyet J., Tan K. C., Salizzoni M., de Hemptinne B. Pediatric liver transplantation: report on 52 patients with a 2-year survival of 86%. J Pediatr Surg. 1988 Mar;23(3):250–253. doi: 10.1016/s0022-3468(88)80733-4. [DOI] [PubMed] [Google Scholar]
  11. Ringe B., Pichlmayr R., Burdelski M. A new technique of hepatic vein reconstruction in partial liver transplantation. Transpl Int. 1988 Apr;1(1):30–35. doi: 10.1007/BF00337846. [DOI] [PubMed] [Google Scholar]
  12. Terpstra O. T., Reuvers C. B., Schalm S. W. Auxiliary heterotopic liver transplantation. Transplantation. 1988 Jun;45(6):1003–1007. doi: 10.1097/00007890-198806000-00001. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES